How Does PTSD Develop?

The psychologists Foa et al. developed the following model to illustrate the psychological process through which PTSD develops.

When a person experiences something which is very traumatic the memory becomes enmeshed into the brain’s circuitry – in essence, a FEAR STRUCTURE becomes incorporated into the brain.

THE FEAR STRUCTURE can be divided into 3 individual units. These are as follows :

a) STIMULI of the trauma. This refers to things which my trigger memories of the trauma. Stimuli my gain access to the brain via any of the 5 senses (i.e. sight, hearing, smell, taste and touch). To use a simple example, someone traumatized by being injured in an explosion in a war may have the trauma response triggered by loud bangs such as fireworks going off (the loud bang being the stimuli).

b) RESPONSES to the traumatic event. This includes both physiological responses (e.g. racing pulse, hyperventilation) and psychological responses (such as a feeling of terror).

c) MEANINGS ATTRIBUTED TO THE STIMULI AND RESPONSES (e.g. this means I must be in great danger).

When somebody suffering from PTSD experiences an event which triggers the original memory of trauma, laid down in the brains circuitry, they feel intense distress. Typically, in response to this distress, they will take evasive action (i.e. try to evade, or get away from, the event which is triggering the traumatic response). It is the meaning aspect of the fear structure ( c, above) which creates the most anguish. The problem lies in the fact that they find it exceptionally difficult to reconcile their old (pre-trauma) beliefs about events and their new (post trauma) beliefs about events (doing this successfully, which therapy can help them, eventually, to do, is known as the PROCESS OF ACCOMMODATION).

An example of pre- and post- traumatic beliefs, which, if the process of accommodation has not taken place, would be in opposition with one another are :

PRE-TRAUMA – the world is a pretty safe place in which I can generally feel relaxed in

POST -TRAUMA – the world is very dangerous and unpredictable and I must always be on my guard against threats which seem to be coming at me from every direction (at worst, leading to clinical paranoia)

COMPULSION TO MAKE SENSE OF THE TRAUMATIC BELIEF

The individual who suffers from PTSD will often try , obsessively, to make sense of the traumatic event which occurred to him/her. This arises because s/he finds it impossible to square what has occurred with pre-trauma beliefs.

THE DEEP PSYCHOLOGICAL PAIN OF TRYING TO MAKE SENSE OF THE TRAUMATIC EVENT

Whilst the individual suffering from PTSD feels driven to make sense of the trauma, constantly thinking about it creates feelings which are both terrifying and overwhelming. THIS CREATES A TERRIBLE PSYCHOLOGICAL TENSION IN THE MIND – there is the PULL TOWARDS ATTEMPTING TO MAKE SENSE OF WHAT HAPPENED ON THE ONE HAND, BUT ALSO THE PULL OF TRYING TO STOP THINKING ABOUT IT ON THE OTHER.

Foa and her colleagues have put forward the theory that it is the tension, created by having one’s thoughts pulled powerfully in two directly opposing directions, which leads to the extreme HYPERAROUSAL (intense anxiety).

The two opposing views of the world the individual tries desperately to fit together (‘safe world’ versus’ unsafe world’) is rather like trying to FIT TWO PIECES OF JIGSAW TOGETHER, ONE OF WHICH HAS BEEN DAMAGED, SO IT NO LONGER FITS.

Therapy can lead to a resolution of this dilemma, leading to a compromise belief, linked to the two opposing beliefs, such as :

THE WORLD IS GENERALLY SAFE FOR ME BUT NOBODY HAS A COMPLETE GUARANTEE, OCCASIONALLY BAD THINGS HAPPEN.